Provider Demographics
NPI:1730544636
Name:MARTIN, JILL J (LMHC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9013 UNIVERSITY PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9421
Mailing Address - Country:US
Mailing Address - Phone:850-478-7800
Mailing Address - Fax:850-478-7802
Practice Address - Street 1:9013 UNIVERSITY PKWY STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9421
Practice Address - Country:US
Practice Address - Phone:850-478-7800
Practice Address - Fax:850-478-7802
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health